<%@page contentType="text/html" pageEncoding="UTF-8"%>
<%@taglib prefix="mwt" tagdir="/WEB-INF/tags/" %>
<!DOCTYPE html>
<!--[if lt IE 7]>      <html class="no-js lt-ie9 lt-ie8 lt-ie7"> <![endif]-->
<!--[if IE 7]>         <html class="no-js lt-ie9 lt-ie8"> <![endif]-->
<!--[if IE 8]>         <html class="no-js lt-ie9"> <![endif]-->
<!--[if gt IE 8]><!--> <html class="no-js"> <!--<![endif]-->
  <head>
    <title>CliniQ</title>
    <%@include file="/commons/head.jsp" %>
    <link rel="stylesheet" href="${path}/css/vendor/datepicker.css">
  </head>
  <body>
    <%@include file="/commons/navbar.jsp" %>
    <div class="container">
      <form id="visit-add" class="form-horizontal">
        <input type="hidden" name="clientId" id="clientId" >
        <div class="control-group">
          <label class="control-label" for="clientName">Client</label>
          <div class="controls">
            <div class="input-append">
              <input type="text" id="clientName" name="clientName" placeholder="Client" readonly="readonly">
              <a id="visit-client-search" class="btn" >Search</a>
              <a id="visit-client-add" class="btn" >New</a>
            </div>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="reasonForConsult">Reason for Consult</label>
          <div class="controls">
            <textarea id="reasonForConsult" name="reasonForConsult" placeholder="Reason for Consult"></textarea>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="historyOfPresentIllness">History of Present Illness</label>
          <div class="controls">
            <textarea id="historyOfPresentIllness" name="historyOfPresentIllness" placeholder="History of Present Illness"></textarea>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="subjective">Subjective</label>
          <div class="controls">
            <textarea id="subjective" name="subjective" placeholder="Subjective"></textarea>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="objective">Objective</label>
          <div class="controls">
            <textarea id="objective" name="objective" placeholder="Objective"></textarea>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="assessment">Assessment</label>
          <div class="controls">
            <textarea id="assessment" name="assessment" placeholder="Assessment"></textarea>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="plan">Plan</label>
          <div class="controls">
            <textarea id="plan" name="plan" placeholder="Plan"></textarea>
          </div>
        </div>
        <div class="control-group">
          <div class="controls">
            <input type="submit" class="btn" value="Register" />
          </div>
        </div>
      </form>
    </div>
    <%@include file="/commons/footer.jsp" %>
      <script src="${path}/js/vendor/bootstrap-datepicker.js"></script>
  </body>
</html>

